Celebrity Chef Reshapes His Connection with Food and Health

More than one third of Graham Elliot -- the nationally known chef and judge on the Fox Network's popular competitive-cooking show, "MasterChef" -- has gone missing.

People become chefs because they appreciate food. Elliot's appreciation, and his waistline, kept pace with his culinary reputation. He joked that "no one trusts a skinny chef." By 2013, however, his trustworthiness had grown a little too apparent. No one would accuse him of skinniness. He weighed almost 400 pounds.

The weight brought health problems. He had inherited a family history of heart attacks and strokes. The excess weight piled on new issues.

"We had exhausted all options."

"I was suffering from hypertension, sleep apnea, gout, constant aches and pains," Elliot said. "I was physically unable to do things a father, husband and parent should be able to do. I was headed for disaster if I didn't make tough decisions, take drastic measures."

Most frustrating for him was his inability to run and play sports with his three young sons (ages 7, 3, and 18 months). After years of testing various standard and imaginative diets, working with a dozen personal trainers and joining multiple gyms, he knew he had to make a change.

"We had exhausted all options," said his wife, Allie.

Making the Commitment

Elliot, 37, had considered weight loss surgery, but was hesitant to take the next step. He asked a friend, fellow chef Grant Achatz, who spoke highly of his care at the University of Chicago Medicine. "So that was where I focused," Elliot said.

Vivek Prachand, MD

At his initial appointment he met Vivek Prachand, MD, an expert in minimally invasive abdominal surgery. "We immediately connected," Elliot said. "He totally understood my unique situation as a chef who happens to be on a food-related TV show. I was worried about not being able to do either, so Dr. Prachand being a foodie was definitely a bonus."

After an extensive multidisciplinary evaluation, followed by a series of discussions and counseling, Elliot underwent obesity surgery on July 16, 2013.

The changes have been remarkable. Before surgery, Elliot could barely run. It was difficult for him to get in or out of a car, tie his shoes or play with his kids. He would have had trouble walking a mile, had he tried. By late November, however, four months after his operation, he was able to finish a five-kilometer race, the Ditka Dash. He covered the 3.1-mile course in less than 35 minutes, averaging a respectable 11 minutes per mile, all while wearing a fake Mike Ditka mustache.

"Running that first 5K was awesome," Elliot said. "Allie was right there beside me, my nurse and cheerleader." They are hoping to run the Chicago Marathon this fall.

By Christmas, Elliot no longer required a machine to keep his airway open while he slept. By March, his weight had dropped from 396 to less than 250 pounds, his blood pressure was nearly normal and his cholesterol levels had radically improved.

"I thought it would take two or three years to do this," he told a reporter from People Magazine. He expected to lose just 60 or 70 pounds the first year. Losing up to 100 pounds would be more typical, according to Prachand, associate professor of surgery, director of minimally invasive surgery, and surgery quality chief at the University of Chicago. But Elliot was not typical.

He did his research, Prachand said. He knew all of his options. He has his family to support and motivate him and he has been "absolutely committed to making the necessary lifestyle modifications that allow his procedure to work most effectively."

A Switch in Time: Nothing Up My Sleeve

There are several surgical options for obese patients; the University of Chicago team has significant experience with all of them. When Elliot first came to the clinic, he saw himself as a candidate for a duodenal switch (DS), a procedure that combines a gastric sleeve with a realignment of the digestive tract that helps patients limit their food intake and decreases calorie absorption.

"The duodenal switch is generally the best option for patients with a body-mass index of 50 or more plus metabolic problems associated with severe obesity," Prachand said. "Graham technically fit those criteria, but as with all of our patients, we had to carefully consider his circumstances, particularly as they related to his career."

Duodenal switch patients lose some of their capacity to process and absorb dietary fats. Even small servings of fatty foods can trigger cramps, bloating, and other intestinal distress.

"Obviously this could interfere with his role as a chef and as a judge of dishes created by contestants on Master Chef," Prachand said. Multiple small tastings is central to Elliot's work.

So Prachand suggested a less extensive operation, called the gastric sleeve, which is one component of the DS. A gastric sleeve makes the stomach about 80 percent smaller, the size and shape of a small banana, but it doesn't interfere with nutrient uptake or digestion.

"It was a reasonable way to start," Prachand said "If it wasn't sufficient by itself; we could follow it with the rest of the DS at a later time."

"Fortunately, Elliot turned out to be an optimal patient," Prachand said. Surgery went smoothly. Elliot recovered quickly and has since been a role model for healthy eating and exercise.

Once a patient commits to surgery and is encouraged by their initial progress, they find it much easier to engage in long-overdue lifestyle changes, Prachand said. Elliot began exercising at least every other day, including longer and longer runs.

"To be honest, I would be fine if he were to put off his marathon goal for at least a year to allow his body to gradually adjust to the physical changes and reduce the risk of injury or burnout," Prachand said. "The key is for movement and exercise to become an inherent and enjoyable part of what we do in our everyday lives, not a set-aside item that is 'nice to do'."

Changing Behavior: The Cool Banana

Elliot has changed the way he eats at home and on the job. No more late-night burgers and Cheez-Its. Now it's salmon or chicken, with salad or vegetables. "I miss ice cream," he admits, but his desserts are more likely to include fruit with cottage cheese, or apple slices dipped in peanut butter.

"I now look at food as fuel and focus on my protein intake," he said. "I'm in love with 'pure' flavors, things that are natural and delicious, minimally fussed with, that showcase the season. I combine that with portion control."

His dressing room on the "MasterChef" set is stocked with almonds and dried fruit. People Magazine published a portrait of Elliot's refrigerator, filled with fat-free yogurts, granola, fruits and vegetables, as well as almond and pumpkin butters and a jar of mayonnaise. A messy ketchup bottle gave the scene some credibility.

He has eliminated almost all bread, pasta, soda and beer, but he still has a sweet tooth. He keeps bananas in the fridge, to remind him, in difficult moments, just how small his stomach has become.

His BMI is down to the 27-29 range, overweight but not obese, and still falling. "When you start out above 50," Prachand said, "29 is fantastic."

"We want patients to lose fat and preserve muscle, bone and other lean body mass," Prachand explained. "Health isn't just about weight or BMI. It's also about what your body is capable of at the new weight." Elliot can now do push-ups and even a few pull-ups. He has increased his cardiovascular endurance and intensity.

"I try not to give weight loss patients precise goals like a certain weight or a specific BMI," Prachand said. "If they miss a single target, it can sap their initiative. But Graham is well into the range where we want him to be right now. He's motivated to stay on top of it and he's really taken to heart the concept of functional fitness rather than a single number on the scale or on a blood test as a measure of health."

Dinner Role Reversal

"I'm a decent cook, but I'm a better surgeon."

Elliot and Prachand still email and text each other frequently, not uncommon during the first year after surgery. Adapting to the changes related to bariatric surgery can be a challenge.

"I've done more than 1,000 minimally invasive weight loss operations and each case is different," Prachand said. "Our team does a phenomenal job of educating patients. But our patients also have to educate us as to what they want to accomplish and what they anticipate. It's truly a collaborative process."

The pressure is now on Prachand. Elliot returns to Chicago in late April, after taping the final episodes of his popular TV show. In May, he will speak at a faculty retreat for University of Chicago surgeons. Later this spring, Prachand has promised to cook a dinner for his patient.

He need not fret. When interviewed briefly in his hospital room two days after his surgery, Elliot, who became the youngest four-star chef in America ten years ago, described the hospital's food as, "pretty good. Really. Not bad at all."

He quickly added a caveat. "Remember, I just had gastric surgery. I can't eat solid food. It's all been pureed."

April 2014

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